Hepatitis B and C — Symptoms, Diagnosis, Treatment & Prevention
Hepatitis B and hepatitis C are viral infections that primarily affect the liver. Both can cause acute hepatitis, but they may also become chronic infections that gradually damage the liver and increase the risk of cirrhosis and liver cancer.
One important problem is that many people have few or no symptoms, particularly during chronic infection. This means someone can have hepatitis for years without knowing it. Blood testing is therefore an important part of diagnosis.
Hepatitis B
Hepatitis B is caused by the hepatitis B virus (HBV). It spreads through infected blood and other body fluids, including semen. It can be transmitted through sexual contact, contaminated needles or sharp instruments, and from an infected mother to her baby during childbirth.
Acute hepatitis B may cause fatigue, fever, nausea, vomiting, loss of appetite, abdominal discomfort, dark urine and jaundice. However, some people have no noticeable symptoms. Chronic hepatitis B can remain silent while inflammation and liver damage gradually develop.
Hepatitis C
Hepatitis C is caused by the hepatitis C virus (HCV) and is mainly spread through contact with infected blood. Common routes include sharing contaminated needles, unsafe medical or dental procedures, unsterile tattoo or piercing equipment, and sharing personal items such as razors that may contain blood.
Hepatitis C often causes no symptoms. When symptoms occur, they can include fatigue, nausea, poor appetite, abdominal discomfort, dark urine and jaundice. Without treatment, chronic hepatitis C can eventually cause fibrosis, cirrhosis and liver cancer.
How are Hepatitis B and C diagnosed?
Diagnosis usually starts with blood tests. For hepatitis B, the important serology includes hepatitis B surface antigen (HBsAg), anti-HBs and total anti-HBc. HBsAg indicates current HBV infection, while anti-HBs generally indicates immunity. The complete pattern of results helps distinguish current infection, previous infection and immunity from vaccination.
For hepatitis C, screening usually begins with an anti-HCV antibody test. A reactive anti-HCV result means the person has been exposed to HCV at some point, but it does not by itself prove that the virus is currently present. HCV RNA testing by PCR or another nucleic-acid test is used to confirm active infection.
Liver enzymes and other blood tests may help assess liver injury. Depending on the situation, doctors may also use ultrasound or other tests to evaluate fibrosis, cirrhosis or complications.
Treatment
Acute hepatitis B is usually managed with supportive care rather than a specific antiviral. Chronic hepatitis B may require long-term antiviral treatment and regular monitoring. Medicines such as tenofovir and entecavir are among the antiviral options used in appropriate patients.
Hepatitis C is different because modern treatment can cure the infection. Direct-acting antivirals (DAAs) are oral medicines that can cure more than 95% of people in many treatment settings, commonly with an 8–12 week course. The exact regimen depends on the patient's clinical circumstances and liver disease.
Prevention
Hepatitis B can be prevented with vaccination. Safe injection practices, properly sterilized medical and dental equipment, safe sex, and screening of pregnant women are also important measures. People should avoid sharing needles, razors, toothbrushes or other items that may be contaminated with blood.
There is currently no vaccine for hepatitis C. Prevention therefore depends mainly on avoiding exposure to infected blood, using sterile equipment for medical procedures, tattoos and piercings, and not sharing injection equipment or personal items that can contain blood. Testing and treatment also help reduce ongoing transmission.
The key difference is that hepatitis B has an effective vaccine and can often be controlled with long-term antiviral therapy, while hepatitis C currently has no vaccine but can usually be cured with modern antiviral treatment.